Preferences and life evaluations of older adults with and without dementia: reliability, stability, and proxy knowledge.

This study assessed the reliability and stability of care preferences and life evaluations among older adults with and without dementia. The study also examined spouse proxy predictions of partner responses. Test-retest reliability over 1 week, stability over 1 year, and proxy knowledge were all moderate to good, but lower for people with dementia. In all 3 areas, however, there was broad interindividual variability. People with dementia may become less reliable and stable in their self-reports, and some spouse proxies may have flawed knowledge about their partner, but dementia status alone is not sufficient to presume poor reliability or knowledge.

Implementation of an obstetrics EMR module: overcoming user dissatisfaction.

To improve quality and efficiency, Henry Ford Health System developed and implemented a new obstetrics application that displays pertinent clinical practice guideline information and standardizes documentation. The initial application included an overview of the patient's vital sign history, a structured note appropriate for each visit and patient educational materials. Despite involvement by clinician subject-matter experts in its design, many clinicians were dissatisfied with the initial application, noting both performance and functionality issues. In response, the health system suspended mandatory use of the application, created a previously unplanned pilot period, made modifications, intensified training and fostered user support. These efforts culminated with clinicians formally voting to accept the application for mandatory use. Understanding the lessons learned from this implementation may help other organizations that are rolling out new information systems.

Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management.

BACKGROUND: Corneal ulcerative disease (CUD) has the potential to adversely affect animal welfare by interfering with vision and causing pain. The study aimed to investigate for the first time the prevalence, breed-based risk factors and clinical management of CUD in the general population of dogs under primary veterinary care in England. RESULTS: Of 104,233 dogs attending 110 clinics participating within the VetCompass Programme from January 1st to December 31st 2013, there were 834 confirmed CUD cases (prevalence: 0.80%, 95% confidence interval (CI) 0.75-0.86). Breeds with the highest prevalence included Pug (5.42% of the breed affected), Boxer (4.98%), Shih Tzu (3.45%), Cavalier King Charles Spaniel (2.49%) and Bulldog (2.41%). Purebred dogs had 2.23 times the odds (95% CI 1.84-2.87, P < 0.001) of CUD compared with crossbreds. Brachycephalic types had 11.18 (95% CI 8.72-14.32, P < 0.001) and spaniel types had 3.13 (95% CI 2.38-4.12, P < 0.001) times the odds for CUD compared with crossbreds. Pain was recorded in 385 (46.2%) cases and analgesia was used in 455 (54.6%) of dogs. Overall, 62 (7.4%) cases were referred for advanced management and CUD contributed to the euthanasia decision for 10 dogs. CONCLUSIONS: Breeds such as the Pug and Boxer, and conformational types such as brachycephalic and spaniels, demonstrated predisposition to CUD in the general canine population. These results suggest that breeding focus on periocular conformation in predisposed breeds should be considered in order to reduce corneal disease.

Randomized Crossover Study Showing Nurse-Led Same Day Review Replacing Next Day Review in Uneventful Phacoemulsification to Be Safe and Efficacious.

Purpose. To study whether nurse led same-day review (SDR) after uneventful phacoemulsification can replace next-day review (NDR) in terms of safety and efficacy. Setting. Patients are recruited from an ophthalmology outpatient clinic in Hong Kong. Design. A prospective, randomized crossover study conducted from November 2012 to 2014. Methods. Inclusion criteria include cataract surgery naïve patients undergoing phacoemulsification under local anaesthesia. All patients were seen by our ophthalmic nurse 2 hours after surgery. Before undergoing phacoemulsification of the first eye, patients were randomized to be reviewed on day 1 or 7 after surgery. Surgeons and reviewing doctors were blinded to patient allocation. For the patients' second eye surgery, group allocation will cross over. Primary outcome measures include visual improvement and patient satisfaction questionnaire. Other measures include cataract characteristics, surgical details, and complications. Statistical tests include paired t-test, Wilcoxon signed rank test, and Chi-square test. Results. 164 eyes from 82 patients were available. Visual improvement, satisfaction, and complications were comparable between both groups. Conclusions. A nurse led SDR can replace NDR in uneventful phacoemulsification in terms of safety and efficacy. Patient satisfaction is also comparable in the setting of Asian culture and when transportation is not a major concern.

Reaction to a dementia diagnosis in individuals with Alzheimer's disease and mild cognitive impairment.

OBJECTIVES: To examine short-term changes in depression and anxiety after receiving a dementia diagnosis. DESIGN: Pre/post survey design. SETTING: Alzheimer's Disease Research Center. PARTICIPANTS: Ninety individuals and their companions. MEASUREMENTS: Fifteen-item Geriatric Depression Scale and 20-item "state" version of the State-Trait Anxiety Inventory. RESULTS: Sixty-nine percent of the individuals were diagnosed with dementia; two-thirds of those were in the earliest symptomatic stages of dementia that, in other settings, is considered to represent mild cognitive impairment. No significant changes in depression were noted in individuals or their companions, regardless of diagnostic outcome or dementia severity. Anxiety decreased substantially after diagnostic feedback in most groups. CONCLUSION: Disclosure of a dementia diagnosis does not prompt a catastrophic emotional reaction in most people, even those who are only mildly impaired, and may provide some relief once an explanation for symptoms is known and a treatment plan is developed.